Successful Multimodal Management of an Aggressive Functional Gonadotropic Pituitary Macroadenoma
Background/Objective: Although most gonadotroph cell–derived pituitary adenomas (PAs) give rise to nonfunctional PAs, hormonally active functional gonadotroph adenomas (FGAs) are exceedingly rare. We present a case of a giant and invasive functional gonadotropic pituitary macroadenoma treated with e...
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Elsevier
2025-01-01
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| Series: | AACE Clinical Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060524001019 |
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| author | Jeffrey J. Feng, MS Sophie M. Cannon, MD Stephanie K. Cheok, MD Mark S. Shiroishi, MD Kyle M. Hurth, MD, PhD Anna J. Mathew, MD Gabriel Zada, MD John D. Carmichael, MD |
| author_facet | Jeffrey J. Feng, MS Sophie M. Cannon, MD Stephanie K. Cheok, MD Mark S. Shiroishi, MD Kyle M. Hurth, MD, PhD Anna J. Mathew, MD Gabriel Zada, MD John D. Carmichael, MD |
| author_sort | Jeffrey J. Feng, MS |
| collection | DOAJ |
| description | Background/Objective: Although most gonadotroph cell–derived pituitary adenomas (PAs) give rise to nonfunctional PAs, hormonally active functional gonadotroph adenomas (FGAs) are exceedingly rare. We present a case of a giant and invasive functional gonadotropic pituitary macroadenoma treated with endoscopic transsphenoidal surgery and subsequent postoperative radiotherapy. Case Report: A 54-year-old man presented with gradually worsening vision over 1 year. Magnetic resonance imaging demonstrated a 5.2-cm sellar and suprasellar mass with cavernous sinus invasion, mass effect on the optic chiasm, and extension into the sphenoid sinus, nasal cavity, and clivus. Preoperative workup was remarkable for erythrocytosis without sleep apnea and increased levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and testosterone. Immunohistochemistry results following endoscopic transsphenoidal resection confirmed dominant staining for steroidogenic factor-1, FSH, and LH. Postoperatively, the patient’s FSH level decreased, whereas the LH level normalized within 1 week. The free testosterone level normalized at 9 months. The patient underwent radiotherapy for a small amount of residual tumor in the right cavernous sinus and has demonstrated no evidence of disease or hormonal progression. Discussion: There is no consensus on FGA-specific management that differs from the management of nonfunctional PAs; surgery is recommended when vision is impacted. The invasive nature of the tumor presented in this case is rare and limited safe gross total resection, requiring adjuvant radiotherapy. Conclusion: FGAs are rare, and those of similar size and extent of invasion as in our case are even more so. In addition to surgical resection, consideration of adjunct therapies including radiation and multidisciplinary physician involvement are vital in achieving clinical improvement and remission while preventing possible progression and recurrence. |
| format | Article |
| id | doaj-art-feabb8e1e4f443d786540f39307e0365 |
| institution | Kabale University |
| issn | 2376-0605 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj-art-feabb8e1e4f443d786540f39307e03652025-01-15T04:11:44ZengElsevierAACE Clinical Case Reports2376-06052025-01-011111417Successful Multimodal Management of an Aggressive Functional Gonadotropic Pituitary MacroadenomaJeffrey J. Feng, MS0Sophie M. Cannon, MD1Stephanie K. Cheok, MD2Mark S. Shiroishi, MD3Kyle M. Hurth, MD, PhD4Anna J. Mathew, MD5Gabriel Zada, MD6John D. Carmichael, MD7Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California; Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MichiganDepartment of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California; Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, David Geffen University of California, Los Angeles School of Medicine, Los Angeles, CaliforniaDepartment of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WisconsinDepartment of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CaliforniaDepartment of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CaliforniaDepartment of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CaliforniaDepartment of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CaliforniaDepartment of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California; Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; Address correspondence to Dr John D. Carmichael, Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine of the University of Southern California, 1520 San Pablo St., #3800, Los Angeles, CA 90033.Background/Objective: Although most gonadotroph cell–derived pituitary adenomas (PAs) give rise to nonfunctional PAs, hormonally active functional gonadotroph adenomas (FGAs) are exceedingly rare. We present a case of a giant and invasive functional gonadotropic pituitary macroadenoma treated with endoscopic transsphenoidal surgery and subsequent postoperative radiotherapy. Case Report: A 54-year-old man presented with gradually worsening vision over 1 year. Magnetic resonance imaging demonstrated a 5.2-cm sellar and suprasellar mass with cavernous sinus invasion, mass effect on the optic chiasm, and extension into the sphenoid sinus, nasal cavity, and clivus. Preoperative workup was remarkable for erythrocytosis without sleep apnea and increased levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and testosterone. Immunohistochemistry results following endoscopic transsphenoidal resection confirmed dominant staining for steroidogenic factor-1, FSH, and LH. Postoperatively, the patient’s FSH level decreased, whereas the LH level normalized within 1 week. The free testosterone level normalized at 9 months. The patient underwent radiotherapy for a small amount of residual tumor in the right cavernous sinus and has demonstrated no evidence of disease or hormonal progression. Discussion: There is no consensus on FGA-specific management that differs from the management of nonfunctional PAs; surgery is recommended when vision is impacted. The invasive nature of the tumor presented in this case is rare and limited safe gross total resection, requiring adjuvant radiotherapy. Conclusion: FGAs are rare, and those of similar size and extent of invasion as in our case are even more so. In addition to surgical resection, consideration of adjunct therapies including radiation and multidisciplinary physician involvement are vital in achieving clinical improvement and remission while preventing possible progression and recurrence.http://www.sciencedirect.com/science/article/pii/S2376060524001019pituitary hormonesfunctional gonadotroph adenomaendocrinologyneurosurgeryradiation therapy |
| spellingShingle | Jeffrey J. Feng, MS Sophie M. Cannon, MD Stephanie K. Cheok, MD Mark S. Shiroishi, MD Kyle M. Hurth, MD, PhD Anna J. Mathew, MD Gabriel Zada, MD John D. Carmichael, MD Successful Multimodal Management of an Aggressive Functional Gonadotropic Pituitary Macroadenoma AACE Clinical Case Reports pituitary hormones functional gonadotroph adenoma endocrinology neurosurgery radiation therapy |
| title | Successful Multimodal Management of an Aggressive Functional Gonadotropic Pituitary Macroadenoma |
| title_full | Successful Multimodal Management of an Aggressive Functional Gonadotropic Pituitary Macroadenoma |
| title_fullStr | Successful Multimodal Management of an Aggressive Functional Gonadotropic Pituitary Macroadenoma |
| title_full_unstemmed | Successful Multimodal Management of an Aggressive Functional Gonadotropic Pituitary Macroadenoma |
| title_short | Successful Multimodal Management of an Aggressive Functional Gonadotropic Pituitary Macroadenoma |
| title_sort | successful multimodal management of an aggressive functional gonadotropic pituitary macroadenoma |
| topic | pituitary hormones functional gonadotroph adenoma endocrinology neurosurgery radiation therapy |
| url | http://www.sciencedirect.com/science/article/pii/S2376060524001019 |
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